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MARY BLACK HEALTH SYSTEM LLC NPI 1578507174


NPI Information

NPI: 1578507174
Provider Name: MARY BLACK HEALTH SYSTEM LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1690 SKYLYN DR
SUITE 300
SPARTANBURG, SC
ZIP 29307
Phone: (864) 582-1201
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MARY BLACK HEALTH SYSTEM LLC is a family medicine in Spartanburg, SC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MARY BLACK HEALTH SYSTEM LLC NPI is 1578507174. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1690 SKYLYN DR
SUITE 300
SPARTANBURG, SC
ZIP 29307-022
Phone: (864) 582-1201
Fax: (864) 596-7409

The provider's authorized official is Debbie Brewer .
The authorized official title is Director Of Provider Enrollment and has the following contact phone number (615) 465-7000.

The enumeration date for this NPI number is 6/15/2006 and was last updated on 7/16/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineNo
2207RG0100XInternal MedicineGastroenterologyNo
3207RI0200XInternal MedicineInfectious DiseaseNo
4207V00000XObstetrics & GynecologyNo
5207X00000XOrthopaedic SurgeryNo
6207Y00000XOtolaryngologyNo
7208000000XPediatricsNo
82085R0202XRadiologyDiagnostic RadiologyNo
9208600000XSurgeryNo
102086S0105XSurgerySurgery of the HandNo
11208800000XUrologyNo
12208C00000XColon & Rectal SurgeryNo
13213E00000XPodiatristNo
14261QR0206XClinic/CenterRadiology, MammographyNo
15207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CE9631OTHERSOUTH CAROLINAMEDICARE RAILROAD
2GP4572MEDICAIDSOUTH CAROLINA
35404MEDICARE PINSOUTH CAROLINA
45298MEDICARE PINSOUTH CAROLINA
5GP4628MEDICAIDSOUTH CAROLINA
6GP1628MEDICAIDSOUTH CAROLINA
7GP4573MEDICAIDSOUTH CAROLINA
85286MEDICARE PINSOUTH CAROLINA
95991MEDICARE PINSOUTH CAROLINA
10GP1325MEDICAIDSOUTH CAROLINA
11GP1610MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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